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ICD-10 Coding for Rotator Cuff Injury(S46.011A, M54.5, M75.1)

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Learn about ICD-10 coding for rotator cuff injuries, including traumatic and non-traumatic tears, documentation requirements, and common coding pitfalls.

Also known as:
Rotator Cuff TearShoulder Tendon Tear
Related ICD-10 Code Ranges

Complete code families applicable to Rotator Cuff Injury

S00-T88Primary Range

Injury, poisoning and certain other consequences of external causes

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Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescription
S46.011AStrain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter
M75.121Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
Primary ICD-10-CM Codes
Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter
S46.011ABillable
Differential Codes

Alternative codes to consider when ruling out similar conditions

Complete rotator cuff tear or rupture of right shoulder, not specified as traumaticM75.121

Use when there is no documented trauma and the tear is due to degenerative changes.

Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounterS46.011A

Use when there is a documented traumatic event leading to a rotator cuff tear.

Documentation & Coding Risks

Avoid these common issues when documenting Rotator Cuff Injury.

Failing to document laterality

Impact

Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials

Mitigation

Always specify right or left shoulder in documentation, Use templates that prompt for laterality

Using M75.10 for unspecified rotator cuff tear when trauma is documented

Impact

Reimbursement: Incorrect coding may lead to denied claims or reduced reimbursement., Compliance: Failure to comply with ICD-10 coding guidelines., Data Quality: Inaccurate data on the nature of the injury.

Mitigation

Use S46.011A with appropriate external cause codes

Incorrect use of 7th character

Impact

Using the wrong 7th character can lead to audit flags.

Mitigation

Educate staff on the importance of 7th character selection based on encounter type.

Frequently Asked Questions

Related condition guides

Documentation requirements, coding pitfalls and FAQs for conditions coded with S46.011A.